Privacy Consent

Agents and brokers are now required to obtain the consent of the consumer prior to assisting with enrollment through the Federal Marketplace (Healthcare.gov) and assisting in applying for advance premium tax credits. Per C.M.S. federal law [45 CFR 155.220(j)(2)(iii)] related to the Affordable Care Act, this privacy consent shall serve as your official notice that William A. Steffen of Steffen Financial Inc will be requesting sensitive and personal information in order to assist in determining your eligibility for health insurance coverage through the Federal Health Insurance Marketplace.

Information collected includes but is not limited to:

Legal name of all proposed applicants

Pimary residential address (county and state)

Dates of birth

Legal residency status

Income data from U.S. tax return and other sources

Employment type and name of employer

Current insurance coverage status

Social Security Number and other related personal identifying numbers

Proof of citizenship and other residency documents

Prior and current incarceration status

Marital status

Tobacco status

Bank or credit card information for premium payments

Pre-existing medical conditions and medications

Additional information may be requested in order to determine eligibility for health insurance via the exchanges. All information provided will remain private, secured and not shared with third party vendors unless necessary for Marketplace enrollment.

When you initiate contact with Steffen Financial Inc, it is implied that you understand, consent and agree to immediately release any personal information required for the sole purpose of providing the best advice and enrolling in health insurance and other health related products. There is no expiration date for this consent unless revoked by the customer.